HIV Incidence on the Increase Among Homosexual Men Attending an Amsterdam Sexually Transmitted Disease Clinic: Using a Novel Approach for Detecting Recent Infections

AIDS. 2002 Jul 5;16(10):F19-24. doi: 10.1097/00002030-200207050-00001.

Abstract

Objective: Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic.

Methods: HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined.

Results: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months.

Conclusion: HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.

MeSH terms

  • Adult
  • Anti-HIV Agents / blood
  • Cross-Sectional Studies
  • HIV Antibodies / blood
  • HIV Infections / blood
  • HIV Infections / epidemiology*
  • HIV Infections / immunology
  • Health Knowledge, Attitudes, Practice
  • Homosexuality, Male
  • Humans
  • Incidence
  • Male
  • Netherlands / epidemiology
  • Outpatient Clinics, Hospital / statistics & numerical data*
  • Risk Factors
  • Urban Population

Substances

  • Anti-HIV Agents
  • HIV Antibodies